PwC’s Health Research Institute (HRI) projects U.S. medical inflation will dip to 6.5 percent in 2016, capping a 10-year trend of slowing employer medical cost-trend growth in the employer-sponsored market. In the latest installment of its annual report Medical Cost Trend: Behind the Numbers, HRI identifies three factors that are expected to reduce the medical growth rate in 2016:
The Affordable Care Act’s looming “Cadillac tax” on high-priced plans which is accelerating cost-shifting from employers to employees to reduce costs;
Greater adoption of “virtual care” technology that can be more efficient and convenient than traditional medical care; and
New health advisers helping to steer consumers to more efficient healthcare.
Despite the year-over-year slowdown, HRI also reported that medical inflation still outpaces general inflation, underscoring the challenges ahead for the health industry. In fact, Behind the Numbers identified two factors that will likely exert inflationary pressure on health spending in the year ahead:
New specialty drugs entering the market in 2015 and 2016 will continue to push health spending growth upward; and
Major cyber-security breaches are forcing health companies to step up investments to guard personal health data, adding to the overall cost of delivering care.
“While the health industry has improved in efficiency over the past decade, the slowing employer medical cost growth is because of the increased role of savvy health consumers facing higher cost-sharing responsibilities and more complex decisions,” said Kelly Barnes, PwC’s U.S. health industries leader. “This will continue to impact the New Health Economy in the coming years.”
“Digitally-enabled care is no longer nice-to-have, it’s fundamental for delivering high quality care,” said Daniel Garrett, health information technology practice leader, PwC US. “Just as the banking and retail sectors today use data and technology to improve efficiency, raise quality, and expand services, healthcare must either do the same or lose patients to their competitors who do so.”
As part of its research, HRI surveyed 1,000 industry leaders, physicians, nurse practitioners and physician’s assistants, including members of the board of the eHealth Initiative, finding that caregivers and consumers share similar views on how digital technology can:
Put diagnostic testing of basic conditions into the hands of patients: About 42 percent of physicians are comfortable relying on at-home test results to prescribe medication.
Increase patient-clinician interaction: Half of physicians said that e-visits could replace more than 10 percent of in-office patient visits, and nearly as many consumers indicated they would communicate with caregivers online.
Promote self-management of chronic disease using health apps: 28 percent of consumers said they have a healthcare, wellness, or medical app on their mobile device, up from 16 percent last year. Roughly two-thirds of physicians said they would prescribe an app to help patients manage chronic diseases such as diabetes.
Help caregivers work more as a team: Nearly half of consumers and 79 percent of physicians believe using mobile devices can help clinicians better coordinate care.
After a five-year contraction in employer healthcare spending growth, medical inflation in the U.S. is projected to rise to 6.8 percent in 2015, according to PwC’s Health Research Institute (HRI). In its annual report, Medical Cost Trend:Behind the Numbers, HRI projects that the stronger economy is now reaching the health sector, releasing a pent-up demand for care and services. Despite some higher utilization and the cost of expensive new cures, the higher expected growth rate in 2015 is modest compared to the double-digit annual increases seen throughout the late 1990s and early 2000s. However, the fact that health spending continues to outpace GDP underscores the need for a renewed focus on productivity, efficiency and ultimately delivering better value for healthcare customers.
Confident consumers are spending more freely on healthcare because of the improved economy, as well as increasing numbers of newly insured, and HRI expects that trend to continue through next year. In addition, the high costs of specialty drugs will increase the healthcare spending growth rate, according to HRI. As exemplified by new Hepatitis C therapies, which are estimated to have a big cost impact next year – responsible for a 0.2 percent increase in spending growth – drug development continues to play an inflationary role in the short run. However, over the long-term, these innovative new therapies may improve quality of life and reduce other medical costs. Other inflationary factors identified by HRI are shifts to higher payments for physician practices acquired by hospitals and health systems, and IT integration investments for large-scale health system mergers and acquisitions.
“Due to a demand for value and increased efficiency in the healthcare industry, medical inflation will be modest this year” said Kelly Barnes, PwC’s U.S. health industries leader. “It is still too early to tell whether the drive for transparency and better value for each healthcare dollar – the cornerstone of the new health economy – will be able to temper spending growth once millions of newly insured access the healthcare system.”
The report notes that additional factors are helping to moderate the growth rate. Three factors holding down spending growth include:
• Healthcare providers gaining efficiencies through ‘systemness’ – streamlining administrative activities and standardizing clinical programs to eliminate redundancies and lower operating costs
• Cost-conscious consumer shopping brought about by employees shouldering more of the financial responsibility for their healthcare
• Risk-based contracts in which healthcare providers are held accountable for patient outcomes
After accounting for likely changes in benefit design, such as higher deductibles and narrow networks, HRI projects a net growth rate of 4.8 percent in 2015. Benefit design changes typically hold down spending growth by shifting financial responsibility to consumers, who often choose less expensive options.